A case of acute respiratory distress syndrome treated with surfactant and low dose methylprednisolone / 소아과

The major pathogenesis of acute respiratory distress syndrome (ARDS) is an inflammatory process that results from a diversity of injuries to the body. Due to the various cytokines and vasoactive peptides released from the endothelium, the vascular permeability is increased; the migration of inflammatory cells and the leakage of plasma proteins then occur and edema develops in the alveolus. There is a hypothesis that the impairment of alveolar recruitment in ARDS is caused by a defect of the surfactant system and the resultant increase of alveolar surface tension. This has been studied in pediatric patients in ARDS; after the administration of surfactant, hypoxia, respiratory symptoms and survival chances were improved. To alleviate the major pathogenic mechanism in this disease, that is to say, inflammation of the lung, steroids have been used and studied as another treatment modality for ARDS, and it has been concluded that the administration of low dose methylprednisolone may improve patients' symptoms and survival rates. We report here on a case of a young infant admitted with ARDS, who, after the intratracheal administration of 120 mg/kg surfactant, on PaO(2)/FiO(2) was elevated. Subsequent low doses of methylprednisolone were given, and the symptoms did not recur, and no fibrotic change was shown during the follow-up period of 2 months.

Comparison of Intervals to Peak Values of Laboratory Findings in Patients with Coronary Complication to Those without Complication in Kawasaki Disease

PURPOSE: Intravenous immune globulin(IVIG) as a treatment for the Kawasaki disease (KD) has reduced the coronary complications. But, some patients suffer from coronary complication despite early IVIG infusion, and it is difficult to discriminate the susceptible patients in the acute phase. It is also challenging to decide additional therapy in cases showing fever after IVIG therapy. We investigated the relationship between intervals from the onset of fever to the day of peak laboratory values and coronary complications. METHODS: We reviewed the charts of KD patients with coronary aneurysm(group A, n=13) and without aneurysm(group B, n=35). All patients got IVIG therapy early in the acute phase and additional therapy in cases fever recurred. We counted the days from onset of fever to the peak level of acute phase reactants and analyzed the differences between two groups with t-test. RESULTS: In the comparison of two groups, the mean intervals from the onset of fever to peak CRP level was 9.23+/-4.71 days in group A, 6.63+/-2.47 days in group B. The mean intervals to peak ESR was 13.31+/-7.06 days in group A, 8.37+/-3.01 days in group B. The mean intervals to highest platelets counts was 14.62+/-4.96 days in group A, 11.14+/-3.59 days in group B. All of these results showed statistically significant differences. CONCLUSION: Our results show that the KD patients with coronary aneurysm have longer intervals between the onset of fever to day of peak acute reactants in spite of the aggressive treatment than those without aneurysm. So, in cases of KD with relapsing fever in spite of IVIG and the acute reactants are in the course of increment, additional immune modulation therapy and short term follow ups with echocardiography would be needed.